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SERVICE REGISTRATION
Registration for On Demand Repair and Support Services Click or Touch "Start" to begin
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Service Type
In Shop (bring or mail in)
Onsite (go where service is needed)
Remote (over a phone or internet)
Mixture
Will this service be performed in our shop, onsite, remotely, or a mixture of those?
Is this for an Individual or an Organization?
Individual
Organization
Are you a returning customer?
Yes
No
Do you agree and consent to the storage of the information entered in this form?
*
Yes, I Agree and Consent
No, I do NOT Agree nor Consent
We will not sell or share your information. If you do not agree then this registration process STOPS HERE and you must contact us to proceed (go back to the home page and click Contact Us)
Name
*
Please provide the name of the organization that would be on the account
Contact Name
First
Last
Please provide the first and last name of the person we will be communicating with for this service
Name
*
First
Last
Please provide the first and last name of the person that would be on the account
Phone Number
*
Please provide the phone number that would be on the account
Contact Phone Number
Please provide the contact phone number for the person listed as a contact for this service
Email
*
Email
Confirm Email
IMPORTANT: Please CONFIRM and VERIFY that this email would be on the account
Contact Email (if needed)
Email
Confirm Email
IMPORTANT: Please CONFIRM and VERIFY that this email is the correct CONTACT email for this service
Mailing Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please provide the mailing address that will be on the account used for billing and contact purposes
Location Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please provide the address where any onsite services will be performed
Do you wish to be contacted by us after this registration?
*
Yes
No
We can call or text you upon registration if you require
When needed which method do you prefer we to contact you?
*
Phone (to the contact phone number provided)
Text (to the contact phone number provided that can receive SMS text messages)
Email (to the email provided)
Servicing Equipment?
Yes
No
Are we going to be servicing any equipment as a part of this service?
Equipment Type
*
Laptop
Desktop
Tablet
Phone
Hard Drive or SSD
Thumb or Flash Drive
Other
Equipment Brand
*
Apple
Dell
HP
Microsoft
Lenovo
Custom or Aftermarket
Other
Mixture
Operating System(s)
*
Microsoft Windows
macOS
Linux
Unix
Other
Please select the Operating System(s) or OS(es) that is installed and running on the equipment
Model Series (e.g. Pavilion, Envy, Inspiron, iMac 27inch 2015, iPhone 12, Galaxy S20)
*
Please enter the model of the equipment to be serviced or enter "unknown" if not known.
Serial Number (or any unique manufacturer number or code on the equipment)
*
Please enter any serial numbers of the equipment to be serviced separated by commas (usually a long code located on the bottom or in the "About" info and preceded by "SN" or "Serial") - if there is nothing like this on the equipment anywhere then type something UNIQUE and SPECIFIC about the appearance of the equipment (e.g. blue and silver with quarter inch straight scratch on top right corner near power port etc.)
Please Select How Many Equipment Units? (10 is 10 or more)
Selected Value:
1
Please select the number equipment units being registered as a target for service. (Desktop, Laptop, Phone, Drive/Disk for Data recovery, etc.)
Warranty
*
None
OEM (manufacturer)
SUPRASEED
Please select the warranty status of the device if known (we do not provide OEM warranty services so we will let you know if warranty service is required by an OEM warranty service provider after equipment inspection)
AC Adapter Included
*
Yes
No
Please select if you will provide an AC Power Adapter for the equipment
How will you provide the Device PIN code or Password?
*
Entered in the boxes below
Will provide on drop-off or arrival
Will provide over Phone or Text later
Please select if you can provide the PIN code or Password for the device now, on arrival, or at a later time over the phone of text message
Device PIN code or Password
Password
Confirm Password
We recommend that you set a temporary admin password and/or PIN on the equipment before the equipment is serviced and enter that temporary PIN code or admin Password here.
Estimated Date and Time of Arrival
Date
Time
Please provide the estimated Date and Time of the equipment arrival to our drop-off location.
Service Details & Error Messages (if it's equipment include the symptoms)
*
Please provide any details you can for the reason of this service registration or any extra information we may need including extra contact info.
File Upload (click the box and select files or drag and drop files into the box)
Click or drag files to this area to upload.
You can upload up to 10 files.
Please upload any files that may help with this service (i.e. documents, pictures, screenshots, notes etc.)
By selecting this box you agree that SUPRASEED Technologies LLC is NOT liable for File and/or Data loss of any kind
(We highly recommend performing a backup of your important files and data (if possible) before having the equipment serviced. When your equipment is in our possession we will always attempt to preserve your files and/or data but you may incur extra charges for this service)
Signature
*
Clear Signature
By signing this form you herby agree that all information and selections you have provided on this form is accurate and correct. (you may sign with your finger or any object that will work on your device)
Phone
Send Registration